Comorbidities, Sphincterotomy, and Balloon Dilation Predict Post-ERCP Adverse Events in PSC Patients: Operator Experience Is Protective

• Published in: Digestive diseases and sciences 2011-12, Vol.56 (12), p.3685-3688
• Main Authors: Alkhatib, Amer A., Hilden, Kristen, Adler, Douglas G.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Antibiotics; Bacterial diseases; Bacterial diseases of the digestive system and abdomen; Biochemistry; Biological and medical sciences; Catheterization - methods; Cholangiopancreatography, Endoscopic Retrograde - adverse effects; Cholangitis, Sclerosing - diagnosis; Cholangitis, Sclerosing - epidemiology; Cholangitis, Sclerosing - surgery; Cholecystitis; Colitis, Ulcerative - diagnosis; Colitis, Ulcerative - epidemiology; Comorbidity; Complications and side effects; Crohn Disease - diagnosis; Crohn Disease - epidemiology; Digestive system; Endoscopic retrograde cholangiopancreatography; Feeding. Feeding behavior; Female; Fundamental and applied biological sciences. Psychology; Gastroenterology; Hepatitis, Autoimmune - diagnosis; Hepatitis, Autoimmune - epidemiology; Hepatology; Human bacterial diseases; Humans; Incidence; Infectious diseases; Investigative techniques, diagnostic techniques (general aspects); Liver cirrhosis; Liver Cirrhosis - diagnosis; Liver Cirrhosis - epidemiology; Male; Medical research; Medical sciences; Medicine; Medicine & Public Health; Medicine, Experimental; Metronidazole; Middle Aged; Oncology; Original Article; Pancreatitis; Prognosis; Radiodiagnosis. Nmr imagery. Nmr spectrometry; Retrospective Studies; Risk Factors; Sphincterotomy, Endoscopic - methods; Sulbactam; Transplant Surgery; Ulcerative colitis; Utah - epidemiology; Vertebrates: anatomy and physiology, studies on body, several organs or systems; Young Adult
• ISSN: 0163-2116; 1573-2568
• DOI: 10.1007/s10620-011-1830-8

Background Primary sclerosing cholangitis (PSC) is a chronic cholestatic disease. Interventional ERCP improves survival in PSC patients. Aims To describe the frequency and risk factors for post-ERCP adverse events in patients with PSC via multivariate analysis. Methods Retrospective cohort study included patients with a diagnosis of PSC who underwent ERCP at academic institutions between February 2000 and October 2009. Demographis, co-morbid conditions, antibiotic use, cannulation method, ERCP maneuvers and 30-day post-ERCP adverse events were collected. Multivariate analysis was performed using logistic regression. Results A total of 185 procedures were performed on 75 PSC patients (58 M,17 F). Seven endoscopists performed ERCPs. Comorbidies included ulcerative colitis (44%, n  = 33), Crohn’s disease (12%, n  = 9 patients), Cirrhosis (8%, n  = 6 patients) and autoimmune hepatitis (2.7%, n  = 2). Cannulation was achieved using dye-free guidewire cannulation techniques in 139/185 procedures (76%) and with contrast-based techniques in 46/185 procedures (24%). Thirty-day post-ERCP adverse events included post-ERCP pancreatitis (5%, n  = 9, cholangitis (1%, n  = 2), acute cholecystitis (0.5%, n  = 1), stent occlusion (0.5%, n  = 1), stent migration (0.5%, n  = 1), and bile leak (0.5%, n  = 1). In the multivariate analysis, associations with specific endoscopists who performed the procedure ( P  = 0.01), biliary dilation ( P  = 0.02), sphincterotomy ( P  = 0.03), presence of cirrhosis ( P  = 0.05), Crohn’s disease ( P